Lace up runners, but tread carefully

With the snow and cold weather now fading, the outdoor running season is in full swing with a plethora of fundraising events. You can jog, walk, push the baby cart and go at your own pace. If you are trying to train for a distance event, such as a 10-kilometre walk or run, and you are not used to these kinds of distances, you need to be aware that running to get into shape means also running to avoid injury. You need to know how much load your body can handle and be realistic about your training goals. Here are the most common running ailments seen in sport medicine and how to avoid them:

1. THE HAMSTRING PULL

This is one injury almost all runners have heard about. If you have not experienced a hamstring pull, then you likely know someone who has. The hamstring is actually not one muscle but a group of muscles at the back of buttock that go down the back of your thigh and cross over the back of the knee. There are several possible factors that contribute to hamstring strain, such as weakness, muscle fatigue and muscle tightness. Muscle imbalances and sacroiliac joint laxity are more common in females, and these can lead to a pull on the hamstring.

Hamstring pulls are best prevented by not running when the hamstring is becoming tight, as well as stretching and strengthening the muscle group and avoiding big increases (10 per cent per week) in training distances each week. Some rehab experts recommend incorporating backwards running into your training to balance the strength of your hamstrings and quadriceps muscles.

2. SHIN SPLINTS

Shin splints are very common in beginner or infrequent runners. The injury is an inflammation of the outer layer of the shin bone (the tibia) and the muscles/tendons that attach to the bone. Pain is felt in the front and inside of the leg, between the knee and the ankle. The main cause of the shin splints is running too much, too soon. The treatment is to decrease the running load and in severe cases, no running for a few weeks. Although other treatments such as orthotics and massage are popular, they will not work without treating the underlying cause of the problem, excess load and impact. Persistent shin splints and increasing pain should be assessed by a physician to rule out a possible stress fracture of the tibia bone.

In order to avoid shin splints, you need to increase your mileage gradually and try running on grass or soft surfaces for part of your run to minimize the stress on the bone. Make sure you have shoes that are not worn out and fit you properly. It is not necessary to buy orthotics because you have shin splints. Most runners recover from shin splints without special shoe inserts.

3. KNEECAP PAIN

The medical term for kneecap pain is patellofemoral pain syndrome. The kneecap (patella) sits in the groove of the thigh bone (femur). The kneecap moves up, down, sideways and turns with knee movement. The exact cause of kneecap pain with running is not clear, but the way the kneecap contacts with the thigh bone with the higher impact is believed to be the source of grief. More impact on the kneecap occurs going downhill than uphill, so downhill is usually more painful. Some runners have problems with improper movement (tracking) of the kneecap at the knee joint. This means that the kneecap may move excessively or at abnormal angles due to muscle imbalances, commonly in the quadriceps muscles. The running impact, combined with improper kneecap movement, leads to kneecap pain. A tight iliotibial band on the side of the thigh can also contribute to kneecap pain. Some foot malalignment problems can also be a factor. However, almost everyone will have a great improvement in their kneecap pain by decreasing their running mileage temporarily. The kneecap pain can also hurt with inactivity and some patients will even experience a swollen knee.

Each individual with kneecap pain needs to be evaluated for possible causes, including running loads. Treatment usually includes focused quadriceps muscle training, including shallow, speed squats. In bothersome cases, patients will need to reduce their running or even stop running and do other cross training temporarily. Some may benefit from arch supports and specific kneecap braces.

FINAL TIP

One thing to remember is that if you are unfortunate enough to sustain one of these injuries, you can usually do some form of low- to non-impact training activity. In fact, sitting on the couch may result in more muscle and joint stiffness. Also, icing after activity is a good idea for a few minutes, although hamstring pain may respond better to heat therapy if there is no significant muscle tear with the swelling. Avoid getting into the habit of taking anti-inflammatories such as ibuprofen before running so you do not feel your pain. You can easily mask the true extent of your injury and this will only prolong your recovery. If you are symptom-free and want to be proactive with strengthening exercises, consult with a physiotherapist, athletic therapist or certified exercise therapist. Be aware of your abilities and possible weak spots in your running program to try and stay injury-free.

Dr. Maureen Kennedy MD, CCFP, FCFP, MSc, PhD(c)Kinesiology, Dip. Sport Med., is a sport and exercise medicine physician at Pan Am Sport Medicine in Winnipeg.

Readers can ask Dr. Kennedy questions, but due to the volume of requests, replies are not guaranteed.

askthedoctor@freepress.mb.ca

Republished from the Winnipeg Free Press print edition April 5, 2011 D3